Breaking Down the Role of Autoimmunity in Chronic Hives

If you’ve been dealing with hives that won’t go away, you might be surprised to learn that your immune system could be attacking itself. Chronic hives (chronic urticaria) often have an autoimmune component, meaning the body mistakenly triggers its own allergic response. Let’s dive into how autoimmunity plays a role in chronic hives and what that means for treatment.

How Autoimmune Chronic Hives Happen

In autoimmune urticaria, the immune system produces autoantibodies that mistakenly activate mast cells, the cells responsible for releasing histamine. This leads to persistent hives, swelling (angioedema), and itching without an obvious external trigger.

Signs Your Hives Might Be Autoimmune-Related

✔️ Hives last longer than 6 weeks, appearing daily or intermittently.
✔️ No clear allergen or external cause (not food, medications, or environmental factors).
✔️ Hives don’t respond well to antihistamines alone.
✔️ Associated swelling of lips, eyes, or face (angioedema).
✔️ You have other autoimmune conditions, such as thyroid disease, lupus, or rheumatoid arthritis.

Autoimmune Conditions Linked to Chronic Hives

People with autoimmune hives are more likely to have:

• Hashimoto’s thyroiditis (autoimmune hypothyroidism)
• Graves’ disease (autoimmune hyperthyroidism)
• Lupus
• Rheumatoid arthritis
• Type 1 diabetes
• Celiac disease

Diagnosing Autoimmune Chronic Hives

If chronic hives are suspected to be autoimmune, your doctor may recommend:

• Thyroid function tests (TSH, T3, T4) – To check for autoimmune thyroid disease.
• Autoantibody tests (Anti-TPO, ANA, anti-IgE receptor antibodies) – To identify immune system involvement.
• A blood test called the Autologous Serum Skin Test (ASST) – Used in research settings to detect autoantibodies in chronic urticaria.

Treatment Options for Autoimmune Chronic Hives

While traditional allergy treatments may not be enough, several advanced options can help:

• High-dose antihistamines – Often needed at higher doses than for typical hives.
• Omalizumab (Xolair) – A biologic injection that blocks IgE, commonly used for autoimmune hives.
• Short-term corticosteroids – Used in severe flare-ups but not ideal for long-term use.
• Immunosuppressants (e.g., cyclosporine, methotrexate) – Sometimes used in difficult cases.
• Thyroid disease treatment – If an autoimmune thyroid disorder is present, treating it may improve hives.

FAQ: Autoimmunity and Chronic Hives

Q: Can autoimmune hives go away on their own?
A: They can, but many cases last for months or years. Proper treatment can significantly reduce symptoms.

Q: Are autoimmune hives dangerous?
A: They are usually not life-threatening but can greatly impact quality of life. If swelling affects breathing, seek emergency care.

Q: Is there a cure for autoimmune chronic hives?
A: There is no cure, but with the right treatment, symptoms can be well-managed.

A Personal Story

One of my patients, Lisa, had daily hives for over a year with no clear allergy triggers. After testing, we discovered she had autoimmune thyroid disease. Once she started thyroid treatment and received omalizumab injections, her hives dramatically improved.

If your hives are persistent and unexplained, autoimmunity could be the missing piece of the puzzle. Seeing a specialist can help uncover the cause and find the best treatment for long-term relief.

What are you waiting for?  If you or your child need help controlling allergies or if you think you need testing or treatment or that you might be a good candidate for allergy shots, Dr. Wendt and her team staff at Relieve Allergy, Asthma & Hives would love to help. Call for testing or treatment today!

Call 480-500-1902 or request an appointment at https://relieveallergyaz.com/contact now!  Begin your allergy testing journey with Dr. Wendt at Relieve Allergy in Scottsdale, Arizona—It’s time to take care of yourself!

Learn more about Dr. Wendt and Relieve Allergy Asthma & Hives at www.relieveallergyaz.com or connect with us: https://www.facebook.com/RelieveAllergy/, https://www.linkedin.com/in/julie-wendt/, https://x.com/RelieveAllergy, https://www.instagram.com/relieve_allergy/ or https://www.youtube.com/@JulieWendt-qx7jm.

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Relieve Allergy Asthma & Hives is located near Kierland Commons, 21803 N. Scottsdale Road Ste. 200, and has convenient evening and morning hours to accommodate your schedule. Dr. Wendt is also available for telemedicine appointments as appropriate. Most insurance plans are accepted.

DISCLAIMER: This blog is not meant to substitute for medical care by an Allergist-Immunologist nor is it intended to provide medical advice or imply a Physician-Patient relationship with its readers or their family. It is intended to provide guidance, direction, and moral support from someone experienced in testing and treating allergies. This is also not meant to be a “do-it-yourself” manual or a “how to” overcome your allergies. Some of the issues mentioned, whether allergic or look-a-like, can be dangerous or if left unchecked, deadly. Please develop a relationship with a Physician you trust to help you with diagnosis, advice, questions, and treatment regarding your and your family’s medical conditions.